Some Communities Make Progress in Reducing Children's Uninsurance

Data Bulletin No. 19October 2000
Michael H. Park, Peter J. Cunningham

Untitled Document

lthough the rates of uninsurance for children nationally
did not change between surveys conducted in 1996-1997 and 1998-19991,
some communities experienced a significant decline in childrens uninsurance
rates during this period, according to recent findings from the Center for Studying
Health System Change (HSC). The childrens uninsurance rates dropped from 7
percent to 3 percent in Boston, from 17 percent to 12 percent in Little Rock
and from 7 percent to 4 percent in Syracuse (see Figure 1).
They also declined in Miami, Greenville and Cleveland, although these decreases
were not statistically significant.

Economic Factors

Decreases in childrens uninsurance rates in these communities may be, in part,
the result of the strong economic growth that occurred across the United States
during this period. These factors may have been particularly important in Boston,
where the decrease in uninsurance rates was due almost entirely to an increase
in private insurance coverage among children. Private insurance coverage is
strongly related to income, and Household Survey data show significant increases
in incomes among Boston-based families with children between the two surveys
and decreases in the percentage of children living below the poverty line (from
16 percent in 1996-1997 to 10 percent in 1998-1999). The findings for Boston
are consistent with a recent report on health insurance coverage in Massachusetts,
in which the robust economy and the private sector were considered to be among
the driving forces behind sharp declines in childrens uninsurance statewide.2

Public Coverage Expansions

Public coverage expansions may also have played a role in the three communities
that experienced the greatest decline in uninsurance rates. A recent report
cited Massachusetts, New York and Arkansas as having been among the most successful
states recently in enrolling children in Medicaid and the State Childrens Health
Insurance Program (SCHIP). 3

Eligibility for public coverage also expanded in other Community Tracking
Study communities, including Northern New Jersey and Orange County, Calif.,
but this has had little apparent impact on childrens uninsurance rates in those
locations. In Greenville, increases in public coverage between the two surveys
were largely offset by decreases in private insurance coverage, resulting in
little or no gain in childrens overall insurance coverage. This latter trend
is similar to what HSC observed nationally for low-income children (see
box: National Trends in Childrens Health Insurance Coverage).

Policy Implications

A recent report of the U.S. Census Bureau indicated that childrens uninsurance
rates declined for the first time after a decade of steady increases. This Data
Bulletin shows that the gains in childrens coverage have been greater in some
communities than others. These gains have occurred in communities with high
uninsurance rates as well as those that already had relatively low uninsurance
rates for children. The result is that some communities, including Boston, Lansing
and Syracuse, now have near universal coverage of children, and others have
been able to make significant inroads into what has been a major problem in
their community.

Nevertheless, there is still considerable variation across communities in childrens
uninsurance rates. Some communities with high uninsurance rates have made little
or no progress in reducing childrens uninsurance, despite substantial expansions
in eligibility for public coverage. It is not clear whether these communities
can replicate the success of communities that have made substantial gains in
childrens coverage.

HSC will continue to monitor the progress of these communities in reducing
childrens uninsurance, and future research will examine economic and policy-related
factors that account for low and high uninsurance rates among children in some
areas.

National Trends in Childrens Health Insurance Coverage

An April 2000 study by HSC found no changes in childrens uninsurance
rates between 1996-1997 and 1998-1999 at the national level. For low-income
children (i.e., in families with incomes below 200 percent of the federal
poverty line), the study found a sharp increase in coverage through Medicaid
or other state insurance programs (e.g., SCHIP), but an equally sizeable
decrease in private insurance coverage. The result was no net gain in coverage
among low-income children nationally.

Notes

1. A recent report from the U.S. Census Bureau based
on the Current Population Survey showed a significant decline in childrens
uninsurance rates nationally between 1998 and 1999 (U.S. Census Bureau, "Health
Insurance Coverage 1999," September 2000). While Figure 1 also shows a slight
decrease in childrens uninsurance rates nationally based on the Community Tracking
Study, this change was not statistically significant. The CTS estimates of change
are also based on different time points than were used in the recent Census
report.

3. Edmunds, M., M. Teitelbaum and C. Gleason. All
Over the Map: A Progress Report on the State Childrens Health Insurance Program.
Washington, DC: Childrens Defense Fund, July 2000.

This Data Bulletin presents findings from the Household Survey, a nationally
representative telephone survey of the civilian, noninstitutionalized population,
as well as 12 randomly selected communities conducted as part of the Community
Tracking Study. The 1996-1997 survey includes nearly 33,000 families and 60,000
individuals, and the 1998-1999 survey includes approximately 32,000 families
and 59,000 individuals.